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Hospital Center

Spotlights

MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014 at 1:30 pm ET). This MLN Connects™ National Provider Call provides an overview of certifying patient eligibility for the Medicare home health benefit. This includes an overview of a new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility. This new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015. For more information and to register, visit this MLN Connects™ National Provider Call web page.

CMS hosted a Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to give feedback on the physician order and physician certification, inpatient hospital admission and medical review criteria, and Part B inpatient billing provisions that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS) final rule (CMS-1599-F). This introductory call allowed for initial discussions between stakeholders and CMS. The transcript and MP3 audio file will be posted to the Special ODF webpage under the "Downloads" section around August 22 and will be available for 30 days. CMS understands that providers or associations may have additional questions or concerns. You are encouraged to submit questions related to the two midnight provision for admission and medical review to the IPPSadmissions@cms.hhs.gov mailbox. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule. CMS will review stakeholder feedback as quickly as possible and provide responses and clarification as needed.

On March 13, 2013, the Centers for Medicare & Medicaid Services (CMS) issued Ruling 1455-R which establishes an interim process for hospitals to bill Medicare for Part B services following a denial of a claim for an inpatient admission as not reasonable and necessary. CMS has issued temporary billing instructions for affected providers to follow for both the Part B Types of Bills (TOB), TOB 12x and TOB 13x.

Revised Fact Sheet for Referral Agents - Where are the Round 2 areas? What if a beneficiary travels? What do you need to know before prescribing a DMEPOS item or referring the beneficiary to a DMEPOS supplier? Want more information on the national mail-order program for diabetic testing supplies?